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Multidomain Intervention to Prevent Cognitive Decline in At-Risk Elderly | Journal Scan
Study Questions:
Is there a benefit from a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population?
Methods:
The FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) study is a double-blind randomized controlled trial in which individuals ages 60-77 years were recruited from previous national surveys for dementia, and enrolled between 2009 and 2011. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. Participants were randomly assigned in a 1:1 ratio to a 2-year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). The primary outcome was change in cognition, as measured through comprehensive neuropsychological test battery (NTB) Z score (higher scores indicate better performance). Analysis was modified by intention to treat (all participants with at least one post-baseline observation).
Results:
A total of 1,260 subjects were randomly assigned, with 591 (94%) participants in the intervention group and 599 (95%) in the control group having at least one post-baseline assessment, and were included in the modified intention-to-treat analysis. Mean age was 69 years and 46% were women. About 65% had hypertension, 70% elevated cholesterol, and 12% diabetes. Mean cognitive performance was <0.5 standard deviation (SD) below the average level for the cognitively normal Finnish population. Estimated mean change in NTB total Z score at 2 years was 0.20 (standard error 0.02, SD 0.51) in the intervention group and 0.16 (0.01, 0.51) in the control group. Between-group difference in the change of NTB total score per year was 0.022 (95% confidence interval, 0.002-0.042; p = 0.030). Overall, 12% of individuals dropped out. Adverse events occurred in 7% of participants in the intervention group compared with 1% in the control group; the most common adverse event was musculoskeletal pain.
Conclusions:
Findings from this large, long-term, randomized, controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population.
Perspective:
This is the first reported randomized trial with a multidomain intervention in at-risk persons with very mild cognitive impairment, and the findings are very encouraging. About one-third of Alzheimer’s disease cases worldwide are estimated to be attributable to seven modifiable factors: low education, midlife hypertension, midlife obesity, diabetes, physical inactivity, smoking, and depression. The authors plan a 7-year extended follow-up to assess intervention effects on incidence of dementia and Alzheimer’s disease and related functional outcomes. Postponing of the onset of Alzheimer’s disease by 5 years has been estimated to decrease its prevalence by up to 50% in 50 years.
Keywords: Dementia, Cognition, Cognitive Dysfunction, Alzheimer Disease, Neuropsychological Tests, Intervention Studies, Intention to Treat Analysis, Cardiovascular Diseases, Musculoskeletal Pain, Diet, Exercise, Geriatrics, Aged, Primary Prevention, Risk Factors, Control Groups, Hypertension, Hypercholesterolemia
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